Provider Demographics
NPI:1972689552
Name:CAPPELLO, JUDITH CLAIRE (DPM)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CLAIRE
Last Name:CAPPELLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-803-0788
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:10700 CHARTER DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-730-0970
Practice Address - Fax:410-730-0161
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD771388600Medicaid
MDH792OtherBLUE CROSS
MDE602OtherNATIONAL CAP BLUE
MD0734830006Medicare NSC
T59790Medicare UPIN